Frectally speaking

Open Source in the NHS.. a landmark is reached

The themes and interests that I explore in my writings cross a range of issues… the complexity of the world, of healthcare, of change, the challenge of change, which often involve a mix of people/process/information and technology..
Within that range you may note a few recurring themes and I return to one of them with this post.
That is that “open source”  is/will be key to the future of healthcare.

When I penned a view back in 2010 that “open source is part of the recipe” several years ago, it was a personal view that few others seemed to share… Over the last few years, its been interesting to see a slow but steady change within healthcare in that direction.
My sense is that in the fullness of time, several key related landmarks will be hailed at pivotal to the future of healthcare.

Back in 2011 the Veterans Health Administration in the US were the pioneers in the field, when leaders as they were and remain, they moved towards the establishment of an open source healthcare ecosystem, to both improve their own healthcare system and encourage others to get involved in new ways of working.

Now in 2013, in the month of July, another key landmark has been reached. Under the leadership of NHS England, the National Health Service in England, has for the first time, publicly declared the “potential benefit created by multiple NHS organisations collaborating ..[on] the ongoing development and improvement of these [open source] products“.
Without wanting to overstate the significance of this “Safer Hospitals, Safer Wards” initiative, I believe this is brave, it is right and is a landmark move towards the future of healthcare.

Lest you get the impression that I’m suggesting that open source is some magical elixir that will cure healthcare on its own.. let me correct you. In fact let me point you to other writings on healthcare penned here… the key points of which are;

Healthcare Systems are examples of Complex Adaptive Systems, which are challenging to change.
Many of the complex healthcare systems around the world are on the “edge of chaos” and require fundamental change.
The common patterns of change that most agree are required in healthcare involve a mix of people, process, information and technology change.. towards a more patient oriented system.. that delivers better value for money.
The financial state of many western economies now mean that such change is no longer an option.. it will be essential.

Within the Information and Technology elements of healthcare, I have made the case elsewhere that the health IT industry could/should provide better solutions than currently exist .. to do so is not just about simply throwing money at the problem, but rather an understanding of the complexity of healthcare, an appreciation of its culture, of the common patterns of process that underpin the diversity of healthcare and a move towards IT tools that can survive and thrive in such an environment.

In earlier work, while involved in the NHS National Programme for IT, I was deeply involved in clinically led work, aimed at supporting key processes in healthcare, with an open, standards-based, architecturally solid approach.. yet hit a wall as I explained at the time. As the NHS moved on from the National Programme for IT, which was in some ways about purchasing  IT systems and rolling them out, the talk has moved  on towards “open standards” and “interoperability” between systems.. yet my experience in this field is that that alone is not enough… many of the current vendors in the market either can not or will not interoperate based on standards alone.  (Which should be read as a critique of the state of both the current Health IT market and current Health IT standards).

Which leads me to reaffirm the role that open source has in healthcare as part of the recipe.

To help explain , I’d like to draw your attention to an image.
Its actually a fractal pattern… (one of my other interests is fractals (hence frectal!).. known as the Sierpinski Triangle.

I use it to illustrate a relatively simple point..
.. that is there exists a hive of activity around the world involving health IT.
From the top of the international tree (eg WHO) down to the many many folk who are tackling change at the frontline in healthcare, many efforts are tackling the same challenges of how do you improve healthcare.. looking to IT to help

At this point in time there are far too few of those efforts joined up and far too much reinvention of the wheel,, over and over and over.

That is not to suggest that any top down imposition of any healthcare solutions (IT or otherwise) will work (we’ve tried that and it doesn’t).
Nor does it suggest that the disconnected Access/Excel health IT hacks that happen all over the world should continue indefinitely.

Rather it suggests that we can now start to connect..

Note:  You’ll also note that every triangle has 3 sides so let me reuse the number 3… 3 times..

What I would suggest is that if for just 3 reasons, I believe “open source” is key the the future of healthcare..

• Unconstrained innovation – ideas and ambitions can be shared by folk who are oceans apart
  If any industry could/should be improved by folk who live miles apart its healthcare.
  I don’t know one doctor who wouldn’t want to share his/her good work with the rest of the medical world.
  The progress of medical science has been based on the spread of ideas..

• Transparent credibility -allowing immediate detailed scrutiny immediately boosts credibility
  Again there is a fit with healthcare.. the “publish or perish” culture of modern medicine demands that healthcare advances are laid open for scrutiny by our peers

• Decentralized control – amendments and improvement can come from the bottom up
  Yet again this fits with healthcare, a complex adaptive system, full of folk who locally innovate and do not/will not wait for top down approval to solve their local need

(I’ve taken these from elsewhere and have repeated them again here as I hope they are helpful)..

Last month I suggested that CCIOs across the NHS may want to make a stand on the important role of open source in the NHS.
Thankfully I didn’t have to try too hard and other CCIO leaders in this field are spreading the open source message.

For information, those 3 groups mentioned in the recent NHS Safer Wards, Safer Hospitals guidance as leading the open source movement in the NHS, Moorfields Eye Hospital, King’s College Hospital and Leeds Teaching Hospitals who began their own journeys at the bottom of the triangle of activity are now moving on to collaborate for the next phase of their work..

On reading this article, you now have at least 3 options with regards to this future!..

Deny it
Ignore it
Embrace it!